大腸がんの身体組成と全身炎症

手術可能な大腸がん患者の身体組成と全身炎症の関係を調査した論文を紹介します。

Richards CH, Roxburgh CSD, MacMillan MT, Isswiasi S, Robertson EG, et al. (2012) The Relationships between Body Composition and the Systemic Inflammatory Response in Patients with Primary Operable Colorectal Cancer. PLoS ONE 7(8): e41883. doi:10.1371/journal.pone.0041883



下記のHPで全文見ることができます。
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0041883

174人の大腸がん患者を対象に、腹部CTで脂肪量と骨格筋肉量を評価しています。全身炎症は白血球数、好中球とリンパ球の割合（NLR）、Glasgow Prognostic Score(mGPS)で評価しています。

mGPSはCRPとアルブミン値で全身炎症を評価する方法で、CRP1mg/dl以下なら0点、CRPが1mg/dl以上でアルブミン値が3.5g/dl以上なら1点、CRPが1mg/dl以上でアルブミン値が3.5g/dl未満なら2点と判定します。

結果ですが、身体組成と白血球数、NLRには有意な関連を認めませんでした。一方、骨格筋指数とmGPSには有意な関連を認めました。CRP、アルブミン値とも骨格筋指数と有意な相関を認めました。がんのステージと骨格筋指数には有意な関連を認めませんでした。

悪液質では全身炎症が筋肉量減少につながっていることが示唆される論文です。筋肉量減少が全身炎症につながっている可能性もありますが。CRP単独、アルブミン値単独でも有用といえる結果ですが、mGPSでみたほうがよりよいのかもしれません。

Abstract

Background

Weight loss is recognised as a marker of poor prognosis in patients with cancer but the aetiology of cancer cachexia remains unclear. The aim of the present study was to examine the relationships between CT measured parameters of body composition and the systemic inflammatory response in patients with primary operable colorectal cancer.

Patient and Methods

174 patients with primary operable colorectal cancer who underwent resection with curative intent (2003–2010). Image analysis of CT scans was used to measure total fat index (cm²/m²), subcutaneous fat index (cm²/m²), visceral fat index (cm²/m²) and skeletal muscle index (cm²/m²). Systemic inflammatory response was measured by serum white cell count (WCC), neutrophil:lymphocyte ratio (NLR) and the Glasgow Prognostic Score (mGPS).

Results

There were no relationships between any parameter of body composition and serum WCC or NLR. There was a significant relationship between low skeletal muscle index and an elevated systemic inflammatory response, as measured by the mGPS (p = 0.001). This was confirmed by linear relationships between skeletal muscle index and both C-reactive protein (r = −0.21, p = 0.005) and albumin (r = 0.31, p<0 .001=".001" and="and" association="association" between="between" index="index" muscle="muscle" no="no" p="p" skeletal="skeletal" stage.="stage." there="there" tumour="tumour" was="was">

Conclusions

The present study highlights a direct relationship between low levels of skeletal muscle and the presence of a systemic inflammatory response in patients with primary operable colorectal cancer.